The purpose of this Mentored Research Scientist Development Award (K01) is to 1) generate knowledge for improving the quality of life in elders disabled with chronic illness and their family caregivers; 2) to provide healthcare providers with empirically- based knowledge that will guide the care for ethnically diverse individuals. For people to utilize health care effectively, they must possess sufficient trust in their healthcare providers. A lack of trust may preclude a positive relationship with healthcare providers and negatively impact treatment decisions. This award will provide the candidate with skills to develop a culturally sensitive instrument that measures trust in health care providers. The research project will assess the effect of trust, religiosity, and personal characteristics of African- American family caregivers on health care decisions regarding cardiopulmonary resuscitation (CPR), mechanical ventilation (MV), tube feeding (TF), and intravenous hydration (IV) for elderly relatives with impairments caused by neurological disorders (dementia or stroke). The study will be guided by the Theory of Reasoned Action as a framework to identify how culturally specific beliefs influence preferences for these life sustaining- treatments. Specific aims are: (1) develop an instrument that measures levels of trust in healthcare providers; (2) determine the relationships among trust in healthcare providers, religiosity, and personal characteristics and their effect on health care intentions regarding CPR, MV, TF, and IV hydration. The aims will be accomplished in two phases. In Phase 1, the trust instrument will be developed. Psychometric techniques will be used to evaluate the instrument for internal consistency reliability, content and construct validity. In addition, item by item effectiveness will be assessed using Rasch model analyses. In Phase 2, the relationships between trust and preferences for life sustaining treatment will be examined in 156 African American family caregivers. The trust measure developed in Phase 1 will be administered, along with measures of other attributes thought to influence treatment decisions, such as religiosity of the caregivers and personal characteristics: patient-caregiver interpersonal relationships, living arrangements, gender, and age. Results of the study will provide insight for healthcare providers that may contribute to decreasing mistrust-related barriers to healthcare. Be delineating the influence of trust, the study will contribute information that can be used to develop effective programs to promote it. Information obtained can be used to facilitate decision making of family caregivers regarding treatment decisions and to develop a culturally-specific health advocacy intervention program for family caregivers.